Building a Medicare Prevention/Wellness Program is Difficult, We Want To Help

Innovative Health Media, LLC is completing its 2016/2017 pilot study in a FQHC this month and will be expanding our offering to other primary care programs including Community Health Centers to include consulting services starting immediately. We realize not every program needs software but from our experience, we have learned that most programs do need logistical and program development support.

We would be honored to help you build your preventive service program. The following are areas we are experts in.

Managing Logistics

Besides our software support, our ability to assist Primary Care Organizations with developing logistics is probably the most useful element to a Prevention/Wellness program that what we offer.

Our consultants will work with your program coordinators to develop a system that effectively:

Creates nurse schedules to maximize the program across the clinical program.

Identify which clinics have maximized the patients and when to move the nurse to another clinic

How best to schedule patients

How to properly assess the productivity of schedulers (wellness coordinators.)

How to managing patient lists

How to check patient eligibility

How to manage ongoing IT issues

How to manage different clinic dynamics

Program Development

To be good for your patients you must first be financially sound. Stressed providers are not as strong as financially secure ones. The Medicare wellness program can be financially beneficial for any program but to be done properly the implementation should be strategically managed.

Strategic Analyst and Business Development Expert

One of our services as a consultant is to help practices with business and program development. At the beginning of developing or redeveloping a program the business development and strategist expert can help you to get all the moving parts into a cohesive program. When you consider the overall potential earnings, a business development specialist is definitely cost effective.

Patient Centered Medical Home

Although PCMH is not an area where we are experts we have working relationships with leaders in PCMH who have been associated with the American Agency for Family Physicians as well as a variety of other PCMH organizations. Depending on your organization’s needs, we can either refer you to experts in this field or work with those experts to get your questions answered.

Business Development

Medicare updates itslist of preventive services annually. We used this list of services to develop our pilot program and therefore can assist you in developing many of these services within your organization. There are several programs that we recommend you consider for your program:

Chronic Care Management – If created effectively, CCM can be the glue that makes all your other Medicare programs work efficiently and cohesively. Of course, a strong CCM program should support both the wellness programs as well as your regular E&M services. All research indicates that care management makes huge inroads into improved patient outcomes. It appears very likely that for FQHCs, CMS will increase reimbursement for CCM from $40 to $60 per patient per month starting this January. For Fee for Service organizations, CMS now offers expanded CCM services which can increase the time nurses can spend with each patient. Although we do not provide software for CCM services we have developed relationships with software programs we can refer to you. We can also assist you in developing your own program using your Electronic Health Record system.

IBT CV (Health Heart Visits) Because the Prospective Payment System for Medicare pays the FQHC the same rate for this visit as it does other codes, we have developed and piloted a program to maximize this visit’s usefulness to your practice and your patients.

IBTO – (Weight Loss Counseling) IBTO is an area where your practice may have the greatest potential to increase patient outcomes as well as reimbursement from the needs identified by the Medicare AWV.

Advance Directives – We are fortunate enough to have developed a relationship with an advance directive software program company who have one of the most highly recommended advance directive systems in the country. This program is free to patients and the cost is minimal to the FQHC to integrate into your EHR system. We are happy to refer you to this company as a resource.

Depression/Cognitive Screening – During our pilot project we included the PHQ2 as part of the Medicare Annual Wellness Visit. Our pilot identified between 25% to 30% of our population were experiencing some level of depression. This is consistent withstudiesthat demonstrate a population that is dealing with chronic illness or negative social determinants of health.

Alcohol Abuse Screening and Counseling – There are two codes associated with alcohol abuse and counseling. The first code is for screening only and we believe this is where a nurse’s intervention should be made. Our approach will be to help your practice decide how to best utilize these codes.

Tobacco Cessation – This code offers several visits throughout the year. Our team will help you determine how best to integrate Tobacco Cessation into your wellness program.

STD prevention is another wellness program that we can assist you with developing. We can help you determine if this visit is best as a wellness program or if it would be more appropriate to integrate it back into the care of the PCP.

Create a Standard of Care Including Standing Orders for the AWV/IPPE

A major challenge we encountered during our pilot was the lack of consistency by providers. As a result of this, the quality measures that should have been met during the visit didn’t reach the potential they should have. We believe the easiest way avoid this problem is to develop a Standard of Care with standing orders for certain services that can be offered at the time of Annual Wellness Visit. We will work with your program to determine what if any standards of care should be implemented.

Increasing Patient Involvement:

Through quality measures and MACRA, Medicare is holding providers responsible for certain patient outcomes. These measures seem to be coming directly from Medicare’s Annual Wellness Visit and IPPE. For this reason, we believe it is imperative that steps are made to show patients what your organization is being held accountable for regarding their health and enroll them into helping reach these quality measures.

The easiest way to do this is to mail a “Statement of Understanding (SoU)” to each of your Medicare patients. The Statement of Understanding should include a list of the measures your organization is held accountable for. The SoU should include a list of things the patient will agree to as a patient of your program. We will work with you to develop a SoU that will include the following:

The patient agrees to:

Sign a SoU to be uploaded into the EHR with other required documents.

Come in for the IPPE/AWV annually

See their provider at least once per year (even if it is only for the AWV or IPPE.)

Listen to the advice of their medical team (including the wellness team) regarding immunizations, wellness programs (such as weight loss, smoking cessation etc.) before declining the use of the program.

Marketing and Educational Services

Prevention and wellness programs are not only new to providers but to your patients as well. Many of your patients will need education about the value of these services before they are willing to come in for services ongoing. We will work with your team to develop the following marketing and educational services:

Introduction to Wellness letters sent that can be sent to each patient describing what the AWV/IPPE is and when they will begin to be offered.

Letters sent to new patients (or new Medicare patients) who need their IPPE or first AWV.

Development of a brochure so front desk staff can give them to the new Medicare patients when they come in with their new Medicare card about the IPPE. The patient should be scheduled for the IPPE at the time the come in with their new card.

Quarterly newsletter that discusses different wellness techniques from your provider experts. The newsletter could also include what clinics we will be at and when and also describe the different preventive services we are offering or will be offering in the future.

The newsletter is also an opportunity to share with our patients what we’ve found such as: ____ lung cancers, ____ colon cancers, ____ heart attacks we prevented, etc.

Programs can also offer the AWV/IPPE as a way to promote its services to the general public. If this is going to work however, the rules providers have about not seeing patients who haven’t been in before for the AWV will need to change.

Threats to the Wellness Program

During our seven years experience working with a variety of clinics to implement the AWV/IPPE and other preventive programs, we have identified several threats to wellness programs in general. One of the most important aspects of our work with you is to address the threats so they are not an issue for your practice.

The following are three areas we see as the most important elements of developing strategic plans to avoid threats:

Provider Ownership – We will work closely with you to develop provider support prior to the establishment of the wellness program.

Consistency – The number one area which has caused wellness programs to disintegrate has been programs that don’t create consistency. If practices pull nurses off of wellness and onto other programs the program will have little chance of success. Whether you are a small practice or large, dedicating specific times for the wellness program will ensure its long term success.

Lack of Training – Wellness is different from care management and different from regular E&M services as well. Certainly, skills used as part of both of these services are also used during the wellness program, there are other skills necessary for success as well. We will work with you to develop curriculum to ensure you program is prepared to continue your wellness program despite staff coming and going.

Our first priority is to ensure that your are successful long term. Whether you need our software, our consulting or both, we can provide ongoing support for your wellness program and be a resource for you, your providers and your staff. Please know we love hearing from you and there is no charge for your first conversation. Give us a call or send us an email and let’s begin the conversation.

To contact us visit our website at www.medicareannualwellnessvisit.com or email me directly at dave@informthepatient.com. Either way, we look forward to hearing from you.